Digital weight loss interventions present a viable and cost-effective alternative to traditional therapy. However, further evidence is needed to establish the equal effectiveness of both approaches. This randomized controlled non-inferiority trial aimed to compare the effects of an intensive in-person weight loss intervention program with Vitadio digital therapy. One hundred patients with obesity and diagnosed with type 2 diabetes, prediabetes, or insulin resistance were enrolled and randomly assigned to one of the two treatment groups. Over a 6-month period, the control group received five in-person consultations with a physician who specialized in obesity treatment, a dietitian and/or a nutrition nurse, while the intervention group followed the digital program based on a multimodal therapeutic approach. The extent of weight loss was assessed and compared between the groups. Additionally, changes in body composition and metabolic parameters for the digital intervention group were analyzed. The study results demonstrated comparable effectiveness of both treatments for weight reduction. The positive effects of Vitadio were further evidenced by favorable changes in body composition and lipid metabolism and improved glycemic control in the intervention group. These findings suggest that Vitadio is an effective tool for assisting patients with managing obesity and preventing diabetes progression.

• MeSH
• diabetes mellitus 2. typu * terapie   MeSH
• dospělí MeSH
• hmotnostní úbytek * MeSH
• inzulinová rezistence MeSH
• krevní glukóza metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita * terapie   MeSH
• prediabetes * terapie   MeSH
• programy na snížení hmotnosti * metody   MeSH
• složení těla MeSH
• telemedicína MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

This review synthesized the evidence from randomized controlled trials comparing the effect of meal replacements (MRs) as part of a weight loss intervention with conventional food-based weight loss diets on cardiometabolic risk in individuals with pre-diabetes and features of metabolic syndrome. MEDLINE, EMBASE, and Cochrane Library were searched through January 16, 2024. Data were pooled using the generic inverse variance method and expressed as mean difference [95% confidence intervals]. The overall certainty of the evidence was assessed using GRADE. Ten trials (n = 1254) met the eligibility criteria. MRs led to greater reductions in body weight (-1.38 kg [-1.81, -0.95]), body mass index (BMI, -0.56 kg/m2 [-0.78, -0.34]), waist circumference (-1.17 cm [-1.93, -0.41]), HbA1c (-0.11% [-0.22, 0.00]), LDL-c (-0.18 mmol/L [-0.28, -0.08]), non-HDL-c (-0.17 mmol/L [-0.33, -0.01]), and systolic blood pressure (-2.22 mmHg [-4.20, -0.23]). The overall certainty of the evidence was low to moderate owing to imprecision and/or inconsistency. The available evidence suggests that incorporating MRs into a weight loss intervention leads to small important reductions in body weight, BMI, LDL-c, non-HDL-c, and systolic blood pressure, and trivial reductions in waist circumference and HbA1c, beyond that seen with conventional food-based weight loss diets.

• MeSH
• chování snižující riziko MeSH
• hmotnostní úbytek * fyziologie   MeSH
• jídla MeSH
• kardiometabolické riziko MeSH
• kardiovaskulární nemoci prevence a kontrola   etiologie   MeSH
• lidé MeSH
• metabolický syndrom * prevence a kontrola   dietoterapie   MeSH
• prediabetes * dietoterapie   terapie   MeSH
• randomizované kontrolované studie jako téma * MeSH
• redukční dieta MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND: The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS: The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS: The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS: The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.

• MeSH
• cvičení MeSH
• diabetes mellitus 2. typu * prevence a kontrola   epidemiologie   MeSH
• lidé MeSH
• mobilní telefon * MeSH
• praktické lékařství * MeSH
• prediabetes * terapie   MeSH
• sedavý životní styl MeSH
• telemedicína * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antihypertenziva terapeutické užití   MeSH
• časná diagnóza MeSH
• diabetes mellitus prevence a kontrola   MeSH
• hypertenze * farmakoterapie   komplikace   MeSH
• klinická studie jako téma MeSH
• kombinovaná farmakoterapie metody   MeSH
• lidé MeSH
• prediabetes * diagnóza   komplikace   terapie   MeSH
• riziko MeSH
• terciární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• novinové články MeSH

BACKGROUND: The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking. METHODS: We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months. DISCUSSION: The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05351359, 28/04/2022).

• MeSH
• cvičení MeSH
• diabetes mellitus 2. typu * prevence a kontrola   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• pragmatické klinické studie jako téma MeSH
• praktické lékařství * MeSH
• prediabetes * terapie   MeSH
• randomizované kontrolované studie jako téma MeSH
• sedavý životní styl MeSH
• telemedicína * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• protokol klinické studie MeSH

• MeSH
• lidé MeSH
• metformin terapeutické užití   MeSH
• prediabetes * diagnóza   psychologie   terapie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

Směrnice, které se zaměřují na diagnostiku a terapii prediabetu. Určeno praktickým lékařům.

• MeSH
• komplikace diabetu MeSH
• praktické lékařství MeSH
• prediabetes diagnóza   terapie   MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• diabetologie
• všeobecné lékařství
• NLK Publikační typ
• brožury

Výskyt prediabetu a DM 2. typu celosvětově stoupá. Řadu let může probíhat skrytě a často bývá zjištěn až při vzniku komplikací (ICHS, CMP, postižení zraku, ledvin, končetin s hrozícími amputacemi). Včasný záchyt onemocnění již ve stadiu prediabetu je zásadní pro včasné zahájení prevence, léčby a oddálení výskytu komplikací. Gestační diabetes mellitus (dále GDM) je významný rizikový faktor rozvoje prediabetu, DM 2. typu, kardiovaskulárních onemocnění a obezity. Ženy s anamnézou GDM mají 40–60% riziko rozvoje prediabetu a DM 2. typu. Jejich preventivním sledováním po porodu lze včas odhalit ženy se vznikající poruchou metabolismu glukózy a zahájit u nich léčbu. Rizikové jsou především ženy s genetickou predispozicí, starší ženy, obézní, PCOS, s vyšším váhovým přírůstkem během těhotenství, pro GDM léčené farmakoterapií. Spolu se stoupajícím výskytem GDM stoupá i výskyt poruchy glukózové tolerance po porodu, což je dáváno do souvislosti s vyšším BMI a věkem těhotných žen. Včasné zahájení léčby, jejíž součástí je dietní opatření, pravidelná fyzická aktivita, redukce hmotnosti a případně léčba metforminem, může zabránit rozvoji DM 2. typu s jeho komplikacemi nebo jej oddálit.

The incidence of prediabetes and type 2 diabetes is increasing worldwide. The course can be asymptomatic for several years and it is often diagnosed once the complications arise (e.g., coronary heart disease, stroke, sight, kidneys, or limbs impairment with impending amputations). Early detection of the disease at the stage of prediabetes is essential for timely prevention, treatment, and delaying complications. Gestational diabetes is a significant risk factor for prediabetes, type 2 diabetes, cardiovascular disease and obesity. Women with a history of gestational diabetes have a 40-60 % risk of developing prediabetes and type 2 diabetes. Postpartum surveillance leads to early detection and treatment of developing glucose metabolism disorders. Increased risk is particularly associated with a genetic predisposition, higher maternal age, obesity, PCOS, higher weight gain during pregnancy, and gestational diabetes treated with pharmacotherapy. In response to the increasing incidence of gestational diabetes, postpartum glucose metabolism disorders also increase. Early initiation of treatment, including dietary measures, regular physical activity, weight reduction, and possibly treatment with metformin, may prevent the onset of type 2 diabetes mellitus and associated complications.

• MeSH
• diabetes mellitus 2. typu * diagnóza   etiologie   terapie   MeSH
• gestační diabetes MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• plošný screening * MeSH
• poporodní období MeSH
• prediabetes * diagnóza   terapie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH

Prediabetes je definován jako hraniční glykemie nalačno nebo porušená glukózová tolerance. Je často součástí metabolického syndromu, a tak představuje vysoké kardiometabolické riziko. Základem léčby prediabetu a prevence diabetu 2. typu a kardiovaskulárních onemocnění je především redukce hmotnosti a pravidelná pohybová aktivita. Je uveden přehled léků vhodných pro pacienty s prediabetem.

Prediabetes is defined as impaired fasting glucose or impaired glucose tolerance. It often appears as a part of metabolic syndrome and then represents high cardiometabolic risk. The cornestones of prediabetes management and Type 2 diabetes and cardiovascular disease prevention are weight reduction and regular physical activity. Suitable drugs for prediabetic patients are mentioned.

• MeSH
• ateroskleróza MeSH
• diabetes mellitus 2. typu * prevence a kontrola   MeSH
• diabetes mellitus * prevence a kontrola   MeSH
• farmakoterapie MeSH
• kouření tabáku MeSH
• lidé MeSH
• metabolický syndrom MeSH
• prediabetes diagnóza   patofyziologie   terapie   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• zdravý životní styl MeSH
• Check Tag
• lidé MeSH

Brožura obsahuje směrnice pro praktické lékaře, které se zaměřují na diagnostiku a terapii prediabetu.

• MeSH
• praktické lékařství MeSH
• prediabetes diagnóza   terapie   MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• diabetologie
• všeobecné lékařství
• NLK Publikační typ
• brožury